A Closer Look at a 2024 Systematic Review and Meta-Analysis on Pain Relief and Improved Mobility When Combining Acupuncture with Physical Therapy

Frozen shoulder is a painful condition that limits how far you can move your arm at the shoulder joint. This post examines a 2024 research article that explored whether adding acupuncture—using an acupuncture needle in various styles, including traditional acupuncture and dry needling—to standard physical therapy improves outcomes for people with frozen shoulder. We’ll break down the findings in plain English to give you a clearer picture of what the study found and how it applies to real-world treatment.

Key Points

• Combined acupuncture and physical therapy significantly reduced shoulder pain.

• Patients who received both treatments showed higher clinical effectiveness rates.

• Range of motion—both active and passive—improved more with the combined approach.

• The study highlights that acupuncture can complement physical therapy by reducing inflammation and modulating pain responses.

• Heterogeneity (variation) existed among studies, largely due to different acupuncture styles and patient populations.

What Is Frozen Shoulder?

Frozen shoulder occurs when the capsule surrounding the shoulder joint becomes inflamed and tight. This inflammation leads to a gradual loss of mobility and increasing pain over time. Although the precise triggers can vary, common factors include:

• Injury or Surgery: Following a shoulder injury or after surgery, prolonged immobility may contribute to developing adhesive capsulitis.

• Medical Conditions: Conditions such as diabetes are known to increase the risk of frozen shoulder.

• Inflammation: Chronic inflammation can lead to thickening and contracture of the joint capsule, limiting movement.

Understanding the nature of this condition is the first step in managing it, as it helps set realistic expectations for recovery.

The Three Stages of Frozen Shoulder

Frozen shoulder typically progresses through three stages: the freezing, frozen, and thawing stages. Each phase presents its own set of symptoms and challenges:

1. Freezing Stage: Increasing Pain and Stiffness

During the freezing stage, the shoulder gradually starts to hurt more and lose its range of motion. Key characteristics of this stage include:

• Pain Onset: The shoulder begins to ache, and the discomfort often intensifies over time. This pain may be most noticeable at night, interfering with sleep.

• Limited Movement: As inflammation sets in, even simple movements can become painful.

• Duration: This phase can last anywhere from several weeks to a few months, setting the stage for more pronounced stiffness.

This stage is critical because early intervention—such as gentle stretching and pain management—can sometimes ease the transition into the next phase.

2. Frozen Stage: Persistent Stiffness

The frozen stage is marked less by pain and more by a significant reduction in shoulder mobility:

• Restricted Movement: While the severe pain of the initial stage may lessen, the shoulder becomes markedly stiff. Everyday tasks, like reaching for items on a high shelf or even getting dressed, can be challenging.

• Daily Impact: The stiffness can interfere with routine activities, affecting both work and personal life.

• Duration: This phase can persist for several months. Although frustrating, this stage is a necessary part of the healing process, as the body works to resolve the inflammation and begin restoring mobility.

Even though it can be discouraging, this stage is an important period during which structured rehabilitation is crucial.

3. Thawing Stage: Gradual Improvement

The final phase of frozen shoulder is the thawing stage, where gradual improvement is the hallmark:

• Recovery of Motion: As the inflammation decreases, the shoulder slowly begins to move more freely. Range of motion improves over time.

• Reduction in Pain: Pain diminishes further as the joint capsule starts to return to its normal elasticity.

• Duration: The thawing phase can last anywhere from several months to over a year. Patience and consistent therapy during this phase are key, as full recovery can be a slow process.

This stage offers hope, as the joint’s function gradually returns, allowing individuals to resume normal activities.

Recognizing Symptoms and Seeking Adhesive Capsulitis Treatment

The common signs of frozen shoulder and adhesive capsulitis include:

• Persistent Shoulder Pain: Often described as a dull ache that intensifies with movement.

• Limited Range of Motion: Difficulty with tasks that require overhead reaching or rotational movements.

• Gradual Onset: Symptoms typically develop slowly over time rather than suddenly appearing.

If you experience these symptoms, it’s important to consult a healthcare professional. Early diagnosis and treatment can help manage pain, improve mobility, and potentially shorten the duration of each stage.

Treatment and Management Strategies

While frozen shoulder can be a long and sometimes painful journey, several treatment options can help alleviate symptoms and promote recovery:

• Physical Therapy:
  A tailored program of gentle stretching and strengthening exercises is often the cornerstone of treatment. Physical therapists can guide you through movements designed to gradually restore shoulder mobility.

• Pain Relief:
  Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to reduce pain and inflammation. In some cases, corticosteroid injections are recommended to manage symptoms during the freezing stage.

• Home Care and Lifestyle Adjustments:
  Applying heat or cold packs, practicing regular, gentle exercises, and avoiding prolonged inactivity can be beneficial. Maintaining an active lifestyle helps prevent further stiffness.

• Acupuncture: Utilizing an acupuncture needle through various techniques—such as traditional acupuncture and dry needling—this treatment method is scientifically recognized for its ability to reduce inflammation, modulate pain signals, and enhance local blood flow. Integrating acupuncture with other therapies can further alleviate symptoms and promote shoulder mobility.

• Advanced Treatments:
  For cases that don’t respond to conservative measures, options like shoulder manipulation or arthroscopic surgery may be considered to improve joint movement.

Study Overview

The systematic review and meta-analysis analyzed data from 13 studies focused on whether the combination of acupuncture and physical therapy could provide better outcomes than physical therapy alone for patients with frozen shoulder or adhesive capsulitis. The researchers included randomized controlled trials, quasi-experimental designs, and nonrandomized studies.

By examining multiple studies, the authors aimed to draw a more reliable conclusion about the effectiveness of combining these two therapies for pain relief, clinical efficacy, and improving joint mobility.

Study Details

• Databases Searched: PubMed, Scopus, Cochrane Trial, and Web of Science.

• Population: Adults (>18 years) with diagnosed frozen shoulder.

• Interventions: Physical therapy alone vs. physical therapy combined with acupuncture (including a range of needle-based techniques such as traditional acupuncture and dry needling).

• Data Analysis:

  • Random-effects models in STATA software.

  • Standardized Mean Differences (SMD) for measuring pain and range of motion.

  • Odds Ratios (OR) for the clinical effective rate.

  • Heterogeneity was assessed using the I² statistic.

Key Findings

• Pain Reduction

  • Patients receiving combined acupuncture and physical therapy reported significantly lower pain (SMD = -0.891).

  • Heterogeneity was high (I² = 85.3%), suggesting study variations in needle techniques or patient demographics.

• Clinical Effective Rate

  • The odds of achieving a favorable clinical outcome were higher with the combined approach (OR = 3.693, I² = 0%).

  • A zero percent I² indicates strong consistency across different studies in this outcome.

• Range of Motion

  • Both active and passive range of motion showed significant improvement when acupuncture was added.

  • The degree of improvement varied (reflected by different levels of heterogeneity), likely due to differences in how interventions were applied.

Study Strengths

• Comprehensive Literature Search: The authors included multiple reputable databases, boosting the likelihood of capturing relevant studies.

• Diverse Study Designs: Looking at various research approaches enhances generalizability.

• Clear Outcome Measures: Pain, clinical effectiveness, and range of motion are tangible clinical metrics.

Study Weaknesses

• High Heterogeneity: Variations in acupuncture styles, treatment frequencies, and patient populations make it harder to compare results directly.

• Limited Sample Sizes: Some included studies may have small participant numbers, reducing statistical power.

• Long-Term Outcomes Unclear: The review primarily focuses on short- to medium-term improvements; sustained benefits are less certain.

Implications for Treatment

The findings suggest that acupuncture—understood scientifically to modulate pain signals, reduce local inflammation, and facilitate blood flow—can amplify the benefits of standard physical therapy. This holistic approach may speed recovery by simultaneously addressing pain, stiffness, and muscle tightness. For clinicians, incorporating an acupuncture style (including dry needling or traditional acupuncture) into rehabilitation programs could lead to better outcomes for patients with frozen shoulder.

Other Thoughts

• Personalized Treatment: Because patients vary in severity and stage of frozen shoulder, tailoring the frequency and style of acupuncture can optimize results.

• Multidisciplinary Approach: Collaborations between physical therapists and trained acupuncture practitioners may further enhance patient success rates.

Conclusion

This systematic review and meta-analysis highlights that adding acupuncture (the use of an acupuncture needle, encompassing techniques like traditional acupuncture and dry needling) to physical therapy can significantly reduce pain, improve clinical success, and enhance both active and passive shoulder range of motion. While high-quality research with larger sample sizes and standardized protocols is still needed, these findings underscore the potential advantage of combining acupuncture with standard care to help patients with frozen shoulder regain mobility and quality of life.

Over to you

If you liked this article, please share with friends and family who may be interested in learning about how acupuncture and physical therapy can work together for frozen shoulder.

Frequently Asked Questions (FAQ)

What is frozen shoulder, and why is it so painful?

Frozen shoulder involves inflammation and stiffness in the shoulder joint capsule. This can make any shoulder movement painful and restrict your range of motion.

How does acupuncture help with frozen shoulder?

Scientifically, inserting an acupuncture needle can stimulate neural pathways to reduce pain, enhance local blood flow, and diminish inflammation. Dry needling, a style of acupuncture, targets specific trigger points within muscles.

What is the main takeaway from this study?

The meta-analysis found that patients who combined acupuncture and physical therapy showed better pain control and range of motion than those who only did physical therapy.

Are the effects of combined treatments permanent?

Most studies evaluated short- to medium-term outcomes, so long-term effects remain less certain. Ongoing research will clarify how lasting these improvements are.

Should I try acupuncture with physical therapy if I have frozen shoulder?

Consult with your healthcare provider. If appropriate, a supervised program blending acupuncture and physical therapy may provide more relief than physical therapy alone.

Sources:

• Xu, B., Zhang, L., Zhao, X., Feng, S., Li, J., & Xu, Y. (2024). Efficacy of combining acupuncture and physical therapy for the management of patients with frozen shoulder: A systematic review and meta-analysis. Pain Management Nursing, 25(6), 596-605. https://doi.org/10.1016/j.pmn.2024.06.009

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